NSAIDS, GOUT and Other Anti-inflammatory Drugs

Question 1

Nonselective reversible COX1 and COX2 inhibitor used for analgesia, antiinflam and antipyrexia

AE: GI bleeding

Answer 1

Ibuprofen

SimD: Ketoprofen, meloxicam, naproxen, mefenamic acid

long-term use: reduce risk of colon Ca

Misoprostol prevents NSAID-induced gastritis
Meloxicam and Piroxicam: COX2 > COX1

Question 2

Nonselective reversible COX1 and COX2 inhibitor used FOR POSTSURGICAL pain control (moderate to severe)

AE: high risk for GI and nephro toxicity

Answer 2

Ketorolac

available as intravenous drug only
USE RESTRICTED TO 72 HOURS only

Question 3

Nonselective reversible COX1 and COX2 inhibitor used as anti-inflam for gout, arthritis, ankylosing spondylitis) and closure of PDA

AE: GI and Nephro tox, aplastic anemia and thrombocytopenia

Answer 3

Indomethacin

Question 4

Selective COX2 inhibitor with minimal GI effects

Answer 4

Celecoxib

SimD: Etoricoxib, parecoxib
Rofecoxib and Valdecoxib - may cause MI and stroke

Question 5

Selective COX3 inhibitor used as analgesic and antipyretic

Answer 5

Paracetamol

Antidote: N-acetylcysteine

Question 6

Paracetamol overdose

Answer 6

Toxic dose: 150mg/kg (21 tabs 500mg)

Lethal dose: 15g (30 tabs 500mg)

Question 7

Antigout drug (inhibits microtubule assembly) used in acute gout, also in familial mediterranean fever

AE: DIC, ARF, alopecia, bone marrow depression (aplastic anemia), peripheral neuritis, myopathy

Answer 7

Colchicine

Question 8

Commonly used in the initial treatment of gout as replacement for Colchicine

Answer 8

Indomethacin

Question 9

Antigout drug/uricosuric agent which may cause NEPHROTIC SYNDROME (probenecid only)

Answer 9

Probenecid

SimD: Sulfinpyrazone

HOWEVER, it may precipitate gout during EARLY PHASE of drug action, prevented by coadministering Colchicine or Indomethacin

Question 10

Antigout drug/xanthine oxidase inhibitor used as FIRST CHOICE for chronic gout and tumor lysis syndrome

AE: CATARACTS, bone marrow dysfunction, aplastic anemia, rash, peripheral neuritis, GI upset

Answer 10

Allopurinol

inhibits metab of mercaptopurine and azathioprine
WITHHELD 1-2 WEEKS after an acute gout
co-administered with colchicine or indomethacin to avoid acute attacks

Question 11

Nonpurine reversible inhibitor/xanthine oxidase inhibitor used in chronic gout, tumor lysis syndrome, allopurinol intolerance
MORE SELECTIVE THAN ALLOPURINOL

AE: liver fcn abnormalities

Answer 11

Febuxostat

WITHHELD 1-2 WEEKS after an acute gout
co-administered with colchicine or indomethacin to avoid acute attacks

Question 12

Goals of Treatment

Answer 12

Chronic gout: to decrease uric acid levels in the blood (ex. Febuxostat, allopurinol), HIGH serum uric acid

Acute gout: to resolve inflammation due to uric acid crystals in joints, serum uric acid levels can be NORMAL